Basic Information
| Provider Information | |||||||||
| NPI: | 1255432126 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MENIFEE COUNTY FISCAL COURT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MENIFEE COUNTY AMBULANCE SERVICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006764785 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 51 LITTLE LEAGUE LANE | ||||||||
| Address2: | |||||||||
| City: | FRENCHBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067683200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 05/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | MAYS | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 6067683200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 1623 | KY | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 612604800 | 01 | KY | FEDERAL LABOR | OTHER | 50011021 | 01 | KY | PASSPORT | OTHER | 55000905 | 05 | KY | MEDICAID | 800619 | 01 | KY | BLACK LUNG | OTHER | P00152651 | 01 | KY | RAILROAD MEDICARE | OTHER | 56025174 | 05 | KY | MEDICAID | 000000317626 | 01 | KY | ANTHEM | OTHER |